Severe Lower Gastrointestinal Bleeding in a Patient with Crohn’s Disease: a Case Report and the Review of Literature

  • Pedram Paragomi Digestive Diseases Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran.
  • Kamran Moradi Digestive Diseases Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran.
  • Pejman Khosravi Mail Digestive Diseases Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran.
  • Reza Ansari Digestive Diseases Research Center, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran.
Keywords:
Crohn’s disease, Inflammatory bowel disease, Severe hemorrhage, Azathioprine, Corticosteroids, Rectosigmoidoscopy

Abstract

Crohn’s disease (CD) is rarely presented with lower GI bleeding (LGIB) which eludes the clinician. A 25-year-old lady with severe rectorrhagia was presented with no history of constipation, diarrhea or abdominal pain. Colonoscopy revealed ulcers in the rectum, sigmoid colon, and terminal ileum. Crohn’s pathologic features were detected in the terminal ileum. The bleeding was controlled via supportive care and IV corticosteroid. Recurrent LGIB was managed by prednisolone and azathioprine. The patient had an uneventful recovery. The clinicians should consider CD as a possible diagnosis in severe LGIB. Prednisolone and azathioprine efficiently control acute bleeding episodes and prevent the recurrence.

References

Baumgart DC, Sandborn WJ. Crohn's disease. Lancet 2012;380(9853):1590-605.

Edwards H. Crohn's disease. An inquiry into its nature and consequences. Ann R Coll Surg Engl 1969;44(3):121-39.

Krause U, Bergman L, Norlen BJ. Crohn's disease. A clinical study based on 186 patients. Scand J Gastroenterol 1971;6(1):97-108.

Rubin M, Herrington JL Jr, Schneider R. Regional enteritis with major gastrointestinal hemorrhage as the initial manifestation. Arch Intern Med 1980;140(2):217-9.

Sparberg M, Joseph B, Kirsner JB. Recurrent hemorrhage in regional enteritis. Report of 3 cases. Am J Dig Dis 1966;11(8):652-7.

Robert JR, Sachar DB, Greenstein AJ. Severe gastrointestinal hemorrhage in Crohn's disease. Ann Surg 1991;213(3):207-11. 7. Belaiche J, Louis E, D'Haens G, et al. Acute lower gastrointestinal bleeding in Crohn's disease: characteristics of a unique series of 34 patients. Belgian IBD Research Group. Am J Gastroenterol 1999;94(8):2177-81.

Kostka R, Lukas M. Massive, life-threatening bleeding in Crohn's disease. Acta chirurgica Belgica 2005;105(2):168-74.

Pardi DS, Loftus EV Jr, Tremaine WJ, et al. Acute major gastrointestinal hemorrhage in inflammatory bowel disease. Gastrointest Endosc 1999;49(2):153-7.

Kim KJ, Han BJ, Yang SK, et al. Risk factors and outcome of acute severe lower gastrointestinal bleeding in Crohn's disease. Dig Liver Dis 2012;44(9):723-8.

Cheifetz AS, Kornbluth AA, Legnani P, et al. The risk of retention of the capsule endoscope in patients with known or suspected Crohn's disease. Am J Gastroenterol 2006;101(10):2218-22.

Daperno M, Sostegni R, Rocca R. Lower gastrointestinal bleeding in Crohn's disease: how (un-)common is it and how to tackle it? Dig Liver Dis 2012;44(9):721-2.

Mantzaris GJ, Christidou A, Sfakianakis M, et al. Azathioprine is superior to budesonide in achieving and maintaining mucosal healing and histologic remission in steroid-dependent Crohn's disease. Inflamm Bowel Dis 2009;15(3):375-82.

Modigliani R, Mary JY, Simon JF, et al. Clinical, biological, and endoscopic picture of attacks of Crohn's disease. Evolution on prednisolone. Groupe d'Etude Therapeutique des Affections Inflammatoires Digestives. Gastroenterology 1990;98(4):811-8.

Mellor JA, Chandler GN, Chapman AH, et al. Massive gastrointestinal bleeding in Crohn's disease: successful control by intra-arterial vasopressin infusion. Gut 1982;23(10):872-4.

Published
2015-11-29
How to Cite
1.
Paragomi P, Moradi K, Khosravi P, Ansari R. Severe Lower Gastrointestinal Bleeding in a Patient with Crohn’s Disease: a Case Report and the Review of Literature. Acta Med Iran. 53(11):728-730.
QRcode
Section
Case Report(s)